1720437155 NPI number — CENTRAL PARK EAR NOSE & THROAT LLP FORT WORTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720437155 NPI number — CENTRAL PARK EAR NOSE & THROAT LLP FORT WORTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL PARK EAR NOSE & THROAT LLP FORT WORTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720437155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 CENTRAL PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76014-2069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-261-9191
Provider Business Mailing Address Fax Number:
817-784-8301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 8TH AVE STE 618
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-335-6336
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BERMINGHAM
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE SERVICES MANAGER
Authorized Official Telephone Number:
817-335-6336

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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